CMS Formulary

Displaying 130881-130890 of 1611142 results.
ID: 130881
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314165
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130882
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 226343
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130883
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1191013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130884
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308493
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130885
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1116150
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130886
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310594
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130887
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 754512
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130888
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 686405
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130889
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 863603
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130890
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2361313
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0